March PARADIGM BYTES

PARADIGM BYTES
Newsletter for Paradigm 97
March 16, 2011

PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste/ bookmark it.

MISSION STATEMENT

We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS

Outcomes Better in Magnet than in Non-Magnet Hospitals?—Not So Fast Potera, Carol

Hospitals designated by the American Nurses Credentialing Center as Magnet facilities are considered to be superior to hospitals without Magnet designation, in terms of nursing excellence, quality of care, and innovations in practice. But a new study suggests that, contrary to what researchers expected to find, non-Magnet hospitals have outperformed Magnet hospitals in several outcomes-related areas, including infection control and post-operative sepsis.
The early studies that compared Magnet with non-Magnet organizations mostly focused on the nursing staffs' work environments and job satisfaction—few studies evaluated differences in patient outcomes. Some early research on mortality rates found that Magnet hospitals had lower mortality rates than non-Magnet hospitals, but as researchers expanded their investigations to include sepsis, pressure ulcers, urinary tract infections, failure to rescue, and other clinical end points, studies suggested that there may be no differences between the two types of hospitals. Some even found that outcomes were better at non-Magnet hospitals. To better understand differences in patient outcomes, researchers analyzed data from 19 Magnet hospitals and 35 non-Magnet hospitals (all of the facilities that were enrolled in the 2005 University Health Systems Consortium operational and clinical databases).
Non-Magnet hospitals were better at preventing postoperative sepsis, postoperative metabolic derangements (complications after elective surgery), and infections related to medical care (involving intravenous lines and catheters, for example). Only rates pertaining to pressure ulcers were slightly lower at Magnet hospitals, and there were no differences in rates of death, failure to rescue, or length of stay.
Differences in staff nursing help to explain the surprising results. On general units, non-Magnet hospitals were better staffed than Magnet hospitals, with 30 more RN hours per week. ICUs exhibited similar differences, with non-Magnet units having 29.9 more RN hours weekly.
So should hospitals still strive to become Magnet facilities? “Absolutely,” says Colleen Goode, the study's lead author and vice president of patient services at the University of Colorado College of Nursing. “They have led the way for improving work environments, recruitment, and retention.” Moreover, data used in the current study came from 2005, when the focus was still on the work environment; the new Magnet model, rolled out in 2008, emphasizes patient outcomes.
Nursing administrators should review outcomes data monthly and examine trends at the unit level. When patient outcomes don't meet benchmark standards, says Goode, “chief nursing officers should pay attention to staffing—both nursing hours per patient day and skill mix.” They should also increase the percentage of nurses with bachelor's degrees to improve patient outcomes.
Evidence-based care prevents adverse events, and Goode advises clinical nurses to follow evidence-based protocols and speak up when others don't stick to them. Some Magnet hospitals offer tuition reimbursement to nurses wishing to obtain a baccalaureate, and nurses should take advantage of this, she says, adding that hospital units with a higher proportion of baccalaureate-prepared nurses have better patient outcomes. Overall, she says, the new Magnet model of 2008, with its focus on patient outcomes, “is the pathway we need to follow.” —Carol Potera
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Evidence-based Practice (EBP)

Define evidence-based practice (EBP). Discuss the key elements in EBP and the role informatics plays in three of these elements.
Evidence-based practice is ”a process, which encompasses the use of best available evidence alongside clinical expertise and the patients’ perspective, to plan care as well as evaluating the performance through a process of self-reflection or peer assessment” (Scott & McSherry, 2009, p.1090). Evidence-based practice is “A core body of nursing knowledge is derived from the process in which research is incorporated into practice; this process has been called best practice, quality of care, and evidence-based practice” (Boswell & Cannon, 2011, p. 23).
Melnyk & Fineout-Overholt (2005) suggested five key elements of evidence-based practice. These are : -

Asking the important clinical question.
Collecting the most relevant and best evidence.
Critically appraising the evidence.
Integrating the evidence with one’s own clinical expertise and patient preferences to make a practice decision.
Evaluating the outcomes of that decision.

References:
Boswell, C. and Cannon, S. (2007). Introduction to nursing research: Incorporating evidence-based practice. Sudbury, MA: Jones and Bartlett
Scott, K., & McSherry, R. (2009). Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing, 18(8), 1085-1095. Retrieved from CINAHL Plus with Full Text database.
http://nursingpub.com/evidence-based-practice


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MED NEWS

Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
Largest Sum Ever Recovered in Single Year

WASHINGTON –Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.
These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.
“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what's been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.” ... http://www.hhs.gov/news/press/2012pres/02/20120214a.html

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FROM A MEMBER

This was sent in by Kurt Ullman referring to Daylight Savings:

When told the reason for Daylight Saving time the old Indian said, "Only a white man would believe that you could cut
a foot off the top of a blanket and sew it to the bottom of a blanket and have a longer blanket."
~Author Unknown


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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days


Bloodstream Infections Associated With Parenteral Nutrition Preparation Methods in the United States

(Abstract) Background: The incidence of bloodstream infection (BSI) among patients receiving parenteral nutrition (PN) is reported to vary widely from 1.3%−39%. BSI rates in a large inpatient population were compared in this study to determine if PN prepared by different methods was associated with BSI. ... http://pen.sagepub.com/content/36/2/169.abstract

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FDA staff focus on safety of Forest lung drug (Reuters) - Drug reviewers said Forest Laboratories Inc and Almirall SA's inhaled lung treatment worked, but raised concerns about potential heart problems linked to drugs in the same class.
Food and Drug Administration staff said on Tuesday the drug, known generically as aclidinium bromide, reduced constriction of the lungs associated with chronic obstructive pulmonary disease (COPD).
COPD is a serious lung disease that makes breathing difficult and is often caused by cigarette smoking. It is the fourth-leading cause of death in the United States and affects about 24 million people, according to the American Lung Association.
But the FDA reviewers said clinical trials may not have been big enough to show potential heart problems. Other drugs in the same class, known as anticholinergic drugs, have been tied to deaths related to heart issues. ...

http://www.reuters.com/article/2012/02/21/us-fda-forest-idUSTRE81K0X920120221?feedType=RSS&feedName=healthNews

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RANDOM FACT: Andy Warhol made over 300 underground films. 'Sleep', the first, simply showed a man asleep for six hours.

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BONUS FACT: In 2006, billionaire collector Eli Broad paid $11.8 million for Warhol's small painting of a can of Campbell's soup.
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Ten facts about Oral Contraceptives: Birth control pills AKA Oral Contraceptives (OCs) have been blamed for a lot of health problems. Most of these health related issues are just myths and evidence based research has ruled them out. The following is a fascinating list of 10 facts about oral contraceptives: - 1. Birth control pills won’t make you gain weight. While maternal hormones like progesterone is associated with weight gain during pregnancy, progesterone based OCs ...

http://nursingpub.com/10-facts-about-birth-control-pills-oral-contraceptives

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FDA acts to stem shortages of two cancer drugs (Reuters) - The U.S. Food and Drug Administration said it will resolve a potentially life-threatening shortage of two leading cancer drugs by allowing one of them to be imported from abroad and rushing approval for a new manufacturer to make the second.
The moves announced on Tuesday mark the latest government effort to address severe drug shortages. More than 200 medicines were in short supply in 2011 and doctors and patient advocates say the crisis has forced providers to postpone care or use second-best or costlier alternatives.
The FDA will allow imports of an alternative to the cancer drug Doxil, which in the next few weeks should meet all patient needs, the agency said. The drug is called Lipodox and has the same active ingredient as Doxil, doxorubicin.
Late on Friday, the FDA also approved a new company, APP Pharmaceuticals, to make preservative-free methotrexate, a drug used to treat children with leukemia. APP is a unit of German healthcare group Fresenius. ...

http://www.reuters.com/article/2012/02/21/us-fda-shortages-idUSTRE81K11A20120221?feedType=RSS&feedName=healthNews
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This excellent letter questioning J&J's campaign was written by Sarah, a nurse on a list serve.

About a week or so ago I sent a request to J&J for Progress reports, the two latest ones, about their "Future of Nursing"
campaign. They have arrived and I was almost shocked to see how little they have to report. What they call
progress amounts to a lot feel good reports of distribution of pamphlets, T-shirts, advertising and facebook sorts of
things. If I were not a nurse I might feel good about J&J and what they are doing for nursing. But I am a
nurse, so I was looking for something tangible. I thought I had found it when they talked about the money they raised
for scholarships. So I went to the www.discovernursing.com website, as directed, and found stories about scholarships,
links to other scholarship sites and nothing (perhaps I didn't pursue it hard enough) that linked me to a site where I could actually learn
about how to apply for a scholarship. The website is not exactly well-maintained. Every page started with a "sorry"
message telling me that if the graphics aren't working I should click on the link, which took me to another page that
said "sorry". So, I'm not sure if the sorry messages would have once led me to more information, but today they do not.
At any rate, J&J says they have raised more than $15 million in nursing scholarships, but I can't find the links to apply. I encourage students on the list to visit the site and see if
they can find some money. If you find it, please apply for some of it. One article in the report says that nursing
satisfaction has improved since 2002, but does not indicate how they know that. There are no numbers in this article.

In fact there are no numbers in this book except as they relate to how many dollars, how many visits to J&J websites, how many t-shirts (100K) or
bumper stickers (350K) they have distributed. But when they talk about nurses and their evaluation of their chosen
profession they talk about nurses in magnet hospitals being more likely to recommend nursing as a profession (how much
more?) and nurses in understaffed hospitals being less satisfied (how much less?). And nurses have not really changed in the way they rate their
relationships with doctors and other nurses (about half call that relationship very good or excellent) since 2002.

So after looking at their material I still have basically the same question I had in the first place -- what has the
campaign done for nursing? Well, besides developing an iPhone app called Happy Nurse.

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Sarah (perrycare44@COMCAST.NET) wrote as a followup on the J&J thread: "When I spoke with the lady on the phone she was pretty focused on students. It seemed to me that students have been defined as the future. The picture I got was one of them not being able to do much about jobs, or what hospitals do,so they are putting their efforts and their money into students.


I tried to get my point across about the fact that I couldn't really tell much from the website or their published annual reports. I had
seen the two most recent annual reports, which seemed to be talking about very soft things and reporting their survey
information in vague terms e.g. "almost half" of RNs, blah blah blah. I tried to point out to her that if nursing education
is really their focus then they might think about using data to report on their the results of the project.

For her part, she expressed regret that I had used a negative report in talking about J&J on this listserv. She directed me to the Peter Beurhaus reports, which are archived and which I ought to be able to find in an internet search,
if I wanted the hard data. She expressed the point of view of J&J as a company that does not do a lot of chest thumping about the great things they are doing.

I still encourage the students on the list to go to the RWJF website and the the NSNA website to look for some of the $18 million dollars in scholarship money that J&J has raised." Sarah

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RANDOM FACT: 7-Eleven is North America's number one retailer of fresh-grilled hot dogs, selling approximately
100 million each year.
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BONUS FACT: Mickey Mouse's first words were "hot Dogs" which he said in the 1929 short 'The Karnival Kid'.


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Doctors scour drug supplies after fake Avastin found (Reuters) - A U.S. distributor of phony vials of the widely-used
cancer drug Avastin aroused suspicion at doctor's offices as early as July, well before health regulators issued their own warning and sparked new alarm over counterfeit medicines.
The U.S. Food and Drug Administration said this week it notified 19 oncology practices they had purchased drugs from a supplier not
approved by the agency, including a counterfeit version of Roche Holding AG's, Avastin, that did not contain the multibillion-dollar drug's
active ingredient, bevacizumab. ...

http://www.reuters.com/article/2012/02/16/us-avastin-idUSTRE81F03220120216?feedType=nl&feedName=ushealth1100
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New Genetic clues to breast cancer. (HealthDay News) -- Researchers have identified three new genomic regions they believe are linked with breast cancer that may help explain why some women develop the disease.
All three newly identified areas "contain interesting genes that open up new avenues for biological and clinical research," said researcher Douglas Easton, a professor of genetic epidemiology at the University of Cambridge in England.
Breast cancer is the most common cancer among women, with about 1 million new cases annually worldwide and more than 400,000 deaths a year.
Scientists conducting genome-wide association studies -- research that looks at the association between genetic factors and disease to pinpoint possible causes -- had already identified 22 breast cancer susceptibility loci. Locus is the physical location of a gene or DNA sequence on a chromosome. ...

http://health.yahoo.net/news/s/hsn/new-genetic-clues-to-breast-cancer?utm_source=NEWS_FOR_NURSES_NEWSLETTER

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RANDOM FACT: One million Americans, about 3,000 each day, take up smoking each year.
Most of them are children.
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Brain scans spot early signs of dyslexia (Reuters) - Instead of waiting for a child to experience reading delays, scientists now say they can identify the reading problem even before children start school, long before they become labeled as poor students and begin to lose confidence in themselves.
Although typically diagnosed during the second or third grade of school - around age 7 or 8 - a team from Children's Hospital Boston said they could see signs of the disease on brain scans in children as early as 4 and 5, a time when studies show children are best able to respond to interventions. ...

http://www.reuters.com/article/2012/01/24/us-usa-dyslexia-idUSTRE80N03320120124?feedType=nl&feedName=ushealth1100
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Fish-oil supplementation enhances the effects of strength training in elderly women
Abstract

Background: Muscle force and functional capacity generally decrease with aging in the older population, although this effect can be reversed, attenuated, or both through strength training. Fish oil (FO), which is rich in n–3 (omega-3) PUFAs, has been shown to play a role in the plasma membrane and cell function of muscles, which may enhance the benefits of training. The effect of strength training and FO supplementation on the neuromuscular system of the elderly has not been investigated.
Objective: The objective was to investigate the chronic effect of FO supplementation and strength training on the neuromuscular system (muscle strength and functional capacity) of older women. ...

http://www.ajcn.org/content/early/2011/12/26/ajcn.111.021915.abstract
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HINT: We all love those meshy show puffs (loofahs) that create great suds while washing up, but they are a breeding ground for bacteria. To keep your loofah in good shape, hang instead of setting down. And toss after about a month of using it.
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The American Diabetes Association offers these guidelines for proper storage of insulin: (Patient teaching)

Insulin typically is stored in the refrigerator, but it may be more painful when injected this way. Insulin stored at room temperature will last about a month.
Don't keep your insulin in extremely hot or extremely cold temperatures.
Never keep insulin in the car, in direct sunlight or in the freezer.
Check the bottle's expiration date, and discard any insulin that's expired.
Inspect the bottle before inserting the syringe to make sure the insulin looks as it should.
Don't use insulin that has formed any crystals or clumps.

http://www.nlm.nih.gov/medlineplus/news/fullstory_121022.html
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I received this from a member... Very interesting. she writes " this link gives access to a number of studies of nursing liability
and claims for the last several years, for both RNs and for NPs, from a big nursing malpractice insurer. There are also links to
past years' reports for NPs. If you are one of those people who always worried about "losing my license" or you're surrounded by
people who are, this might be interesting reading." The reports are from NSO

http://www.nso.com/nursing-resources/claim-studies.jsp?refID=nurseclaimreport2011
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RANDOM FACT: Viagra: This drug was accidentally created when Pfizer chemists were developing a pill to treat
cardiovascular ailments. However, when it was tried out on test subjects, something came up (literally).
The pill, later named Viagra and approved by the FDA in 1998, proved a bust in terms of treating heart disease, but its unexpected side effect opened the doors for a brand-new industry.
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Pills as good as stents for stable heart patients: analysis (Reuters) - Treating stable heart patients with a handful of pills works just as
well as propping open blocked heart arteries with a stent, U.S. researchers said on Monday, adding to evidence that less-invasive,less-costly drug treatment works as well as implanting a medical device in such patients.

Stents, made by companies such as Boston Scientific Corp, Abbott Laboratories and Medtronic Inc, are still the preferred treatment for opening up blocked heart arteries in patients rushed to the hospital with an acute heart attack. But several studies have shown the heart devices are no better than drugs in patients with stable heart disease, in which heart arteries have narrowed and may be causing chest pain. ... http://www.reuters.com/article/2012/02/28/us-heart-stents-drugs-idUSTRE81R00D20120228?feedType=RSS&feedName=healthNews

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Debate over conscience in the workplace intensifies (Reuters)
Can a state require a pharmacy to stock and dispense That's the question at the heart of a

long-running legal battle in Washington state, expected to be decided Wednesday with a ruling from U.S. District Court in
Seattle. It's the latest twist in a contentious national debate over the role of conscience in the workplace.

In recent weeks, the debate has been dominated by religious groups fighting to overturn a federal mandate that most health insurance plans provide free birth control. But the battle extends far beyond insurance regulations. ...

http://www.reuters.com/article/2012/02/21/us-usa-contraceptives-court
-idUSTRE81K24W20120221?feedType=RSS&feedName=healthNews

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U.S. advisers back experimental obesity pill (Reuters) - Experimental obesity drug Qnexa won the backing of U.S. health advisors on Wednesday, raising hopes for approval of the first prescription weight-loss pill in 13 years.
Vivus Inc's Qnexa was one of three promising obesity drugs rejected by the U.S. Food and Drug Administration in the past two years over safety concerns. A panel of outside experts to the FDA voted 20-2 to recommend approval of Qnexa, saying they were convinced that the benefits it offers in treating obesity outweighed the potential heart risks and birth defects associated with the drug.

It is the first to come back up for review after more extensive clinical trials, as public health officials urge the FDA to consider a medical treatment for a condition that affects about one-third of Americans. ... http://www.reuters.com/article/2012/02/23/us-fda-obesity-vivus-idUSTRE81L2AS20120223?feedType=RSS&feedName=healthNews ***********************

Report Affirms Lifesaving Role of Colonoscopy A new study provides what independent researchers call the best evidence yet that colonoscopy — perhaps the most unloved cancer screening test — prevents deaths. Although many people have assumed that colonoscopy must save lives because it is so often recommended, strong evidence has been lacking until now. In patients tracked for as long as 20 years, the death rate from colorectal cancer was cut by 53 percent in those who had the test and whose doctors removed precancerous growths, known as adenomatous polyps, researchers reported on Wednesday in The New England Journal of Medicine. ... http://www.nytimes.com/2012/02/23/health/colonoscopy-prevents-cancer-deaths-study-finds.html?_r=1&utm_source= NEWS_FOR_NURSES_NEWSLETTER **************************

Up Close With Distance Education A multitude of largely positive studies have been done to assess online learning for nurses.
Most everyone in the nursing field is somewhat acquainted with computers and internet resources. Despite familiarity, many astute nurses are hesitant to polish their computer skills and pursue an online graduate level education in spite of the desire and the attractiveness of the opportunity.
To quell the anxieties of potential students, distance education is broken down into easily digestible components that define characteristics
for success, graduate program selection and computer specifications and skills.
The distance education medium transcends multiple disciplines creating immense possibilities. The traditional brick and mortar campus has given way to the convenience of virtual space, any place at all times....
http://nursing.advanceweb.com/Features/Articles/Up-Close-With-Distance-Education-2.aspx?utm_source=NEWS_FOR_ NURSES_NEWSLETTER
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Group backs HPV shot recommendation for boys (Reuters Health) -

Boys 11 years and up should get Merck & Co's Gardasil vaccine to protect them against HPV infections, which can cause genital warts as well as oral, penile and anal cancers, the nation's largest group of pediatricians said Monday. "What we are hoping will come out of this is that we can push this as a cancer vaccine," said Dr. Michael Brady of the American Academy of Pediatrics (AAP). "We now have the ability to interrupt the transmission and the development of cancer."
The new statement leans on recommendations released last year by U.S. vaccine advisers and updates the previous stance of the AAP, which until now had only backed routine vaccination for girls. ... http://www.reuters.com/article/2012/02/27/us-hpv-shot-recommendation-boys-idUSTRE81Q0NZ20120227?feedType= RSS&feedName=healthNews

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Promoting Evidence-Based Practice Internship program enables RNs to create their own protocols of care

So much to read, so little time.
That's the oft-heard lament of book lovers: subtract the hours spent working, raising kids, cooking, cleaning and other imperatives, and the cruel arithmetic of modern life leaves little time to immerse oneself in Stephen King or Jane Austen.
Nurses face the same predicament. Every day, scores of clinical trials, research papers and meta-analyses appear in print or electronic form. But what nurse who serves on a super-busy staff, manages a floor of needy patients, and charts diligently and thoroughly - what nurse, however dedicated, has time to ingest even a fraction of all that knowledge? Answer: A staff nurse at the University of Iowa (UI) Hospitals and Clinics in Iowa City.
Since 2000, UI has offered a formal internship program that allows its nurses to take time off their regular duties and investigate how to solve some problem of care that intrigues them. First, a UI nurse plunges into a thorough review of existing literature about the problem. Then she leads an effort to institute a protocol to eliminate the problem, resulting in improved patient care and potential financial savings for UI long-term.
To secure one of these mini-sabbaticals, a nurse "has got to be passionate about a topic," said Laura Cullen, MA, RN, FAAN, who coordinates UI's internship program. "And you want to pick topics that can be win-wins, that don't have a lot of land mines."...
http://nursing.advanceweb.com/Features/Articles/Promoting-Evidence-Based-Practice.aspx?utm_source=NEWS_FOR_NURSES NEWSLETTER

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HYDROGEN PEROXIDE


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A tablespoon of 3% hydrogen peroxide solution in a cup of water can be used as a mouthwash -
swish for up to 60 seconds once a day; but don't swallow and be sure to rinse your mouth out afterwards. This can also help whiten teeth
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Hydrogen peroxide in a 3% solution applied to a rag can be used to clean bench tops and cutting boards to help kill
salmonella and other bacteria.
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